Cryoprecipitate Dosing for Transfusion

Indications for Cryoprecipitate Administration

The American Society of Anesthesiologists recommends cryoprecipitate administration when fibrinogen concentration is less than 1.5-2.0 g/L in the presence of significant bleeding 1, 3
Cryoprecipitate is indicated when thromboelastometric signs show a functional fibrinogen deficit 1, 3
The American Society of Anesthesiologists recommends cryoprecipitate as an adjunct in massively transfused patients when fibrinogen concentrations cannot be measured in a timely fashion 4
Cryoprecipitate is indicated for patients with congenital fibrinogen deficiencies 4

The initial dose of cryoprecipitate for significant bleeding is 50 mg/kg, which is approximately equivalent to 15-20 units in a 70 kg adult 1, 2
For patients with plasma fibrinogen level <1 g/L, 3-4 g of fibrinogen concentrate or equivalent cryoprecipitate dose is recommended 5

Fibrinogen levels should be measured before and after administration to guide dosing 5
Either laboratory assessment of fibrinogen concentration or viscoelastic monitoring of functional fibrinogen should be used 5
In trauma patients, a maximum clot firmness of 7 mm on thromboelastometry correlates with a fibrinogen level of approximately 2 g/L 1, 3

Fibrinogen is often the first coagulation factor to decrease critically during massive blood loss replacement 1, 3
During postpartum hemorrhage, fibrinogen plasma concentration <2 g/L has a positive predictive value of 100% for progression to severe bleeding 1
Transfusion of cryoprecipitate is rarely indicated if fibrinogen concentration is greater than 150 mg/dL in non-pregnant patients 4